Spinal tuberculoma in a patient with spinal myxopapillary ependymoma

Intramedullary spinal tuberculosis is a clinical curiosity. A 19-year-old female was diagnosed and treated for lumbosacral myxopapllary ependy moma (MPE). Three years later, she presented with back pain and hypoesthesia of the left upper limb. Besides revealing local recurrence, the MRI demonstrated a fresh lesion in the cervicomedullary area. The latter was operated and the histopathology revealed a tuberculoma

Morbidity Patterns in Oncology Patients at FMRI, Gurgaon:A Hospital Based Study at a New Tertiary Care Institute

Objective: This study aims to analyze the patterns of morbidity amongst cancer patients attending a tertiary care hospital.Materials and Methods: Data were collected from various departments dealing in cancer care. Patient’s data were categorized according to diagnosis and place of residence.Results: A total of 1490 new cancer patients were registered. Out of these 1140 were Indians from 22 different states {males= 609 (53.4%) and females= 531 (46.6%)} and remaining 350 patients were from 27 different countries {males= 223 (63.7%) and females=127 (36.3%)}. The five most common cancer site groups amongst all males (n=832) were digestive organs (18.6%) followed by lymphoid, hematopoietic and related tissue (16.8%);  respiratory intrathoracic organs (14.1%); then eye, brain and other parts of central nervous system (11.4%) and lip, oral cavity and  pharynx (9.5%)  and in all females (n=658) the most common cancer site were breast (31.5%) followed by  genital organs (17.3%); digestive organs (11.2%); lymphoid, hematopoietic and related tissue (9.3%) and eye, brain and other parts of nervous system (9.0%).Conclusions:  The present study highlights the pattern of cancer among patients in a corporate tertiary health care institute. There is therefore an inherent bias, the leading sites of malignancies amongst Indian males and females varied from that in the Western population; this could be attributed to various cultural, environmental factors, life style, genetic factors etc. in different regions of India and different nations of the world.

Consistency analysis for the performance of planar detector systems used in advanced radiotherapy

Purpose: To evaluate the performance linked to the consistency of a-Si EPID and ion-chamber array detectors for dose verification in advanced radiotherapy.Methods: Planar measurements were made for 250 patients using an array of ion chamber and a-Si EPID. For pre-treatment verification, the plans were generated on the phantom for re-calculation of doses. The γ-evaluation method with the criteria: dose-difference (DD) ≤ 3% and distance-to-agreement (DTA) ≤ 3 mm was used for the comparison of measurements. Also, the central axis (CAX) doses were measured using 0.125cc ion chamber and were compared with the central chamber of array and central pixel correlated dose value from EPID image. Two types of statistical approaches were applied for the analysis. Conventional statistics used analysis of variance (ANOVA) and unpaired t-test to evaluate the performance of the detectors. And statistical process control (SPC) was utilized to study the statistical variation for the measured data. Control charts (CC) based on an average , standard deviation ( ) and exponentially weighted moving averages (EWMA) were prepared. The capability index (Cpm) was determined as an indicator for the performance consistency of the two systems.Results: Array and EPID measurements had the average gamma pass rates as 99.9% ± 0.15% and 98.9% ± 1.06% respectively. For the point doses, the 0.125cc chamber results were within 2.1% ± 0.5% of the central chamber of the array. Similarly, CAX doses from EPID and chamber matched within 1.5% ± 0.3%. The control charts showed that both the detectors were performing optimally and all the data points were within ± 5%. EWMA charts revealed that both the detectors had a slow drift along the mean of the processes but was found well within ± 3%. Further, higher Cpm values for EPID demonstrate its higher efficiency for radiotherapy techniques.Conclusion: The performances of both the detectors were seen to be of high quality irrespective of the radiotherapy technique. Higher Cpm values for EPID indicate its higher efficiency than array

Validation of an integrated patient positioning system: Exactrac and iViewGT on Synergy Platform

Purpose: Evaluation of the newly integrated system for its validation and designing a quality assurance frame work to assess its geometrical, radiological and mechanical accuracy.Methods: Isocentric accuracy of two independent imaging modalities, kV based ExacTrac and MV based iViewGT was evaluated using Winston-Lutz test. A pelvic humanoid phantom was used for the radiological end-to-end test for its clinical utilization. Image quality for the systems was evaluated using Las Vegas Phantom and ETR-1 plate. The kV system was also assessed for kVp accuracy, kVp - dose linearity, mAs-dose linearity and timer linearity and its accuracy. The system was tested for total filtration and output consistency. Tests for uniformity and noise measurement of kVp accuracy and its reproducibility, linearity test between applied kVp and the x-ray dose, linearity Test between applied mAs and the x-ray dose were also done. Results: Winston-Lutz test gave the isocentric deviation of 0.058 ± 0.015 mm with the average lateral deviation as 0.028 ± 0.021 mm, average longitudinal deviation as 0.032 ± 0.015 mm and average vertical deviation as 0.030 ± 0.016 mm. With the phantom test, the minimum measured displacement of Exactrac positioning was 0.2 ± 0.3 mm, 0.0 ± 0.2 mm and 0.1 ± 0.3 mm in longitudinal, lateral and vertical directions respectively. In image quality test, visible smallest visible hole size seen by both Exactrac and EPID imaging system was 5 mm and can resolve 1.5 lp/mm or better. The image uniformity was found to be 132.9 ± 3.06 pixels for MV images and 139 ± 4.41 pixels for kV images with the associated noise of ≤1% both for 120 kV-20 mAs and 4 MV beam energy of ExacTrac and iViewGT respectively. The uniformity and noise test, measured pixel intensity values for various points on MV and kV images separately were found to agree within ± 1% with respect to the central axis pixel value. The kVp accuracy and its reproducibility were tested for kV imager only. The deviation of kVp was found to be than ± 1% and its precision was seen to be even lesser than ± 0.1%. Linearity test between applied kVp and the x-ray dose and applied mAs and x-ray dose were tested only for the ExacTrac. Both the coefficient of linearity for kVp as well as mAs was found to be < 0.1. Conclusion: It is feasible to install ExacTrac imaging system with an Elekta linear accelerator. Both the imaging systems were found to be compatible in terms of image quality test and isocentric accuracy and can be used for the patient imaging in the same Linear accelerator.-----------------------------Cite this article as: Jassal K, Munshi A, Sarkar B, Paul S, Sharma A, Mohanti BK, Ganesh T, Chougule A, Sachdev K. Validation of an integrated patient positioning system: Exactrac and iViewGT on Synergy Platform. Int J Cancer Ther Oncol 2014; 2(2):020212. DOI: 10.14319/ijcto.0202.1

Resource-sparing and cost-effective strategies in current management of breast cancer

Looking down on cattle walking through fenced path.GrayscaleSorensen Safety Negatives, Binder: North & Central America

External hypofractionated whole-breast radiotherapy: Now where does accelerated partial breast irradiation stand?

Breast-conserving therapy (BCT) has emerged as a viable option for suitable breast cancer patients who are desirous of preserving the breast. The major advantage of BCT is the good cosmetic outcome with disease-free and overall survival similar to mastectomy. In this article, I have compared two emerging modalities for treating a preserved breast with radiotherapy. These two techniques in breast cancer - accelerated partial breast irradiation (APBI) and hypofractionated whole breast external beam radiotherapy - have their respective merits and drawbacks, and this article attempts to dissect the issue